Rich Shayna E, Shardell Michelle, Margolis David, Baumgarten Mona
Department of Epidemiology and Preventive Medicine, School of Medicine, University of Maryland, 660 West Redwood Street, Baltimore, MD 21201, USA.
Nurs Res. 2009 Mar-Apr;58(2):95-104. doi: 10.1097/NNR.0b013e31818fce8e.
Clinical guidelines for the prevention of pressure ulcers advise that pressure-reducing devices should be used for all patients at risk of or with pressure ulcers and that all pressure ulcers should be documented in the patient record. Adherence to these guidelines among elderly hospital patients early in the hospital stay has not been examined in prior studies.
The objective of this study was to examine adherence to guidelines by determining the frequency and correlates of use of preventive devices early in the hospital stay of elderly patients and by determining the frequency and correlates of recording pressure ulcers in the patient record.
This was a cross-sectional study of 792 patients aged 65 years or older admitted through the emergency department to the inpatient medical service at two teaching hospitals in Philadelphia, Pennsylvania, between 1998 and 2001. Patients were examined by a research nurse on Hospital Day 3 (median of 48 hours after admission) to determine the use of preventive devices, presence of pressure ulcers, and risk of pressure ulcers (by Norton scale). Data on additional risk factors were obtained from the admission nursing assessment in the patient record. Data on documentation of pressure ulcers were obtained by chart abstraction.
Only 15% of patients had any preventive devices in use at the time of the examination. Among patients considered at risk of pressure ulcers (Norton score < or =14), only 51% had a preventive device. In multivariable analyses, high risk of pressure ulcers was associated with use of preventive devices (odds ratio = 41.8, 95% confidence interval = 14.0-124.6), whereas the type and stage of pressure ulcer were not. Documentation of a pressure ulcer was present for only 68% of patients who had a pressure ulcer according to the research examination.
Use of preventive devices and documentation of pressure ulcers are suboptimal even among patients at high risk.
预防压疮的临床指南建议，对于所有有压疮风险或已发生压疮的患者，均应使用减压装置，且所有压疮情况均应记录在患者病历中。此前的研究尚未对老年住院患者在住院早期对这些指南的遵循情况进行过检查。
本研究的目的是通过确定老年患者住院早期预防性装置的使用频率及相关因素，以及确定患者病历中压疮记录的频率及相关因素，来检查对指南的遵循情况。
这是一项横断面研究，研究对象为1998年至2001年间通过急诊科入住宾夕法尼亚州费城两家教学医院内科住院部的792名65岁及以上的患者。在住院第3天（入院后中位数48小时），由一名研究护士对患者进行检查，以确定预防性装置的使用情况、压疮的存在情况以及压疮风险（通过诺顿量表评估）。从患者病历中的入院护理评估中获取有关其他风险因素的数据。通过查阅病历获取压疮记录的数据。
在检查时，只有15%的患者使用了任何预防性装置。在被认为有压疮风险的患者（诺顿评分≤14）中，只有51%使用了预防性装置。在多变量分析中，压疮高风险与预防性装置的使用相关（比值比 = 41.8，95%置信区间 = 14.0 - 124.6），而压疮的类型和阶段则不然。根据研究检查，只有68%有压疮的患者病历中有压疮记录。
即使在高风险患者中，预防性装置的使用和压疮记录情况也未达到最佳状态。
